Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 38
with a mortality rate close to 100% if not treated within 12 to
24 hours (7).
C. septicum is a normal commensal of the human intestinal
tract and is ubiquitous in the environment. It is notorious for
causing gas gangrene in the absence of trauma (8), which makes
the diagnosis challenging without a high index of suspicion. It
can produce several toxins including deoxyribonuclease, lecithinase, hyaluronidase, and hemolysins, which can lead to tissue
necrosis, disseminated intravascular coagulation, intravascular
thrombosis, and hemolysis.
Factors causing defective host immunity, such as steroids,
diabetes, neutropenia, and alcohol abuse, might lead to translocation of the bacteria. This organism has been reported to
cause several infections, including clostridial myonecrosis (8),
osteomyelitis, septic arthritis, panophthalmitis, aortitis, intraabdominal abscess, intracranial infections, and abdominal wall
cellulitis. Localized pain, inflammation, crepitation, gas production, disproportionate tachycardia, discolored edematous skin,
and features of systemic toxicity are features that raise clinical
suspicion (9). Gas may be seen in tissues on x-rays and computed tomography scans in cases of gas gangrene and is due to
the production of nitrogen and hydrogen by the organism.
Even with effective treatment, including debridement and
antibiotics, the mortality rate approaches 60% (10). The drug of
choice for this infection is penicillin G. The extended-spectrum
cephalosporins, carbapenems, and metronidazole are the usual
alternatives in patients allergic to penicillins. Clindamycin, being a protein synthesis inhibitor, is believed to help reduce toxin
production by the organism. Amputation might be needed when
limb salvage is not possible. No controlled studies are available
112
regarding the use of hyperbaric oxygen therapy. Another concern
regarding hyperbaric oxygen therapy is that compared with other
clostridia, this organism has more tolerance to oxygen (11).
Factors associated with poor prognosis are presentation with septic
shock, immunosuppression, liver disease, and delay in initiation
of treatment.
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2. Katlic MR, Derkac WM, Coleman WS. Clostridium septicum infection
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3. Sebald M, Hauser D. Pasteur, oxygen and the anaerobes revisited. Anaerobe
1995;1(1):11–16.
4. Maclennan JD. The histotoxic clostridial infections of man. Bacteriol Rev
1962;26:177–276.
5. Alpern RJ, Dowell VR Jr. Clostridium septicum infections and malignancy.
JAMA 1969;209(3):385–388.
6. Wentling GK, Metzger PP, Dozois EJ, Chua HK, Krishna M. Unusual
bacterial infections and colorectal carcinoma—Streptococcus bovis
and Clostridium septicum: report of three cases. Dis Colon Rectum
2006;49(8):1223–1227.
7. Chew SS, Lubowski DZ. Clostridium septicum and malignancy. ANZ J
Surg 2001;71(11):647–649.
8. Abella BS, Kuchinic P Hiraoka T, Howes DS. Atraumatic clostridial myone,
crosis: case report and literature review. J Emerg Med 2003;24(4):401–405.
9. Furste W, Dolor MC, Rothstein LB, Vest GR. Carcinoma of the large
intestine and nontraumatic, metastatic, clostridial myonecrosis. Dis Colon
Rectum 1986;29(12):899–904.
10. Larson CM, Bubrick MP, Jacobs DM, West MA. Malignancy, mortality,
and medicosurgical management of Clostridium septicum infection. Surgery
118(4):592–597.
11. Hill GB, Osterhout S. Experimental effects of hyperbaric oxygen
on selected clostridial species. II. In-vitro studies in mice. J Infect Dis
1972;125(1):26–35.
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Baylor University Medical Center Proceedings
Volume 27, Number 2